NPIMap

Organization Active NPI

Abundant Living Group Home, Inc

Doing business as New Abundant Living I

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Eden, NC
National Provider Identifier
1164616835
Registry record updated Sep 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
MHL-079-076 Issued in NC
Legal business name
ABUNDANT LIVING GROUP HOME, INC
Doing business as
New Abundant Living I
Practice address
438 Creekridge Dr
Eden, NC 27288-2817
Phone
(336) 623-7669
Fax
(336) 623-1139
NPI assigned
Sep 5, 2007
Last updated
Sep 5, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Janice Aniece Timpson
Title
Owner
Phone
(336) 623-7669

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL-079-076 NC Primary

Addresses

Primary practice location

438 Creekridge Dr
Eden, NC 27288-2817

Mailing address

438 Creekridge Dr
Eden, NC 27288-2817
Phone (336) 623-7669

Other names 1

  • New Abundant Living I Doing business as

National Provider Directory

National Provider Directory
Tax ID family
New Abundant Living 33 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188950400000",
    "number": "1164616835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "438 CREEKRIDGE DR",
            "city": "EDEN",
            "state": "NC",
            "postal_code": "272882817",
            "telephone_number": "336-623-7669",
            "fax_number": "336-623-1139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "438 CREEKRIDGE DR",
            "city": "EDEN",
            "state": "NC",
            "postal_code": "272882817",
            "telephone_number": "336-623-7669",
            "fax_number": "336-623-1139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABUNDANT LIVING GROUP HOME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-05",
        "last_updated": "2007-09-05",
        "status": "A",
        "authorized_official_last_name": "TIMPSON",
        "authorized_official_first_name": "JANICE",
        "authorized_official_middle_name": "ANIECE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-623-7669",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-079-076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Abundant Living I",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eden, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.